ulcerative colitis
Introduction
Introduction to ulcerative colitis Ulcerative colitis (UC), referred to as ulceration, is not fully elucidated, mainly chronic non-specific inflammatory disease invading the colonic mucosa, often from the left colon, to the proximal end of the colon and even the whole colon, The continuous approach is gradually progressing. The clinical symptoms vary in severity, and there may be remission and episodes. Patients may have only colon symptoms or systemic symptoms. basic knowledge The proportion of illness: 0.023% Susceptible people: no specific population Mode of infection: non-infectious Complications: peritonitis colon cancer rectal cancer
Cause
Cause of ulcerative colitis
(1) Causes of the disease
The exact cause of ulcerative colitis is still unclear. There are several theories about the etiology of this disease.
Infection factor (35%):
It has been proved that certain bacteria and viruses play an important role in the pathogenesis of ulcerative colitis. The pathological changes and clinical manifestations of this disease are very similar to those of bacterial dysentery. In some cases, bacteria are cultured in feces, and some cases are effectively treated with antibiotics. It seems that bacterial infection is associated with this disease. In 1973, Fakmer cultured cytomegalovirus (CMV) from 6 cases of ulcerative colitis. In 1977, Cooper also isolated cytomegalovirus from patients with toxic colonic expansion. Some studies have found that mycobacterium paratuberculosis, paramyxovirus (paramyxovirus), Listeria moncytogenes, etc. may also be associated with ulcerative colitis and Crohn's disease. It is related to the disease, so it is suggested that some bacteria or viruses may play an important role in the pathogenesis of ulcerative colitis, but which pathogen infection causes the disease, whether the infectious pathogen is the cause of the disease or the result requires further research. determine.
Immunological factors (28%):
People who hold this view believe that autoimmune-mediated tissue damage is one of the important factors in the pathogenesis of ulcerative colitis. Some authors have found that some pathogens (such as E. coli, etc.) that invade the intestinal wall have cross-antigens with human intestinal epithelial cells. When the body infects these pathogens, the autoantibodies in the circulation not only kill the pathogens in the intestinal wall but also kill their own epithelial cells. In recent years, a 40KD antigen has been found in the colonic epithelium of patients with ulcerative colitis. It activates the body to produce anti-colon epithelial antibodies and also activates complement and antigen-antibody complexes on the surface of colonic epithelium. After activation of immune lymphocytes and macrophages in patients with ulcerative colitis, a variety of cytokines and vasoactive activities are released. Substance, promotes and aggravates the inflammatory response of tissues, has reported the role of CD95 (TNF-like)-mediated colonic epithelial cell apoptosis in the pathogenesis of ulcerative colitis, and found in areas of colonic inflammation in patients with ulcerative colitis CD95-CD95L-mediated apoptosis occurs in adjacent non-inflammatory regions, inferred to be ulcerative One of the possible causes of the spread of enteritis.
In addition, in recent years, it has been reported that antibodies and T lymphocytes in the body's circulation interact with heat shock protein (HSP) in intestinal epithelial cells of patients with ulcerative colitis, resulting in intestinal epithelial damage in ulcers. The results of T, B lymphocyte count determination, blood leukocyte, macrophage and lymphocyte transformation rate in patients with colitis suggest that the disease is related to changes in cellular immunology.
Genetic factors (15%):
Some data indicate that ulcerative colitis is closely related to genetic factors. The racial difference is higher in Caucasians than in blacks, and Asians have the lowest incidence. Among them, the incidence of Caucasian Jews is higher than that of non-Jews. 2 to 4 times, and about 50% less in colored people, the incidence of twin twins is higher than that of twins, and some authors report an increase in tissue-associated antigen HLA-DR2 in patients with ulcerative colitis. Japanese scholars have recently reported that the specific gene phenotype P-ANCA (peinuclear antineutrophil cytoplasmic antibody) found in patients with ulcerative colitis is significantly higher than the normal population.
Mental factors (15%):
The role of mental factors in the pathogenesis of ulcerative colitis may be related to the autonomic dysfunction caused by mental disorders, leading to inflammation of the intestinal wall and ulcer formation, but some authors have compared the patients with ulcerative colitis with the normal population. There is no obvious mental incentive. On the contrary, after colectomy due to ulcerative colitis, the patient's original mental morbidity such as depression, anxiety, nervousness and suspicious symptoms are significantly improved. It seems that the mental factor is not caused by this. The cause of the disease is more like the consequences of the disease.
(two) pathogenesis
1. Ulcerative colitis in the lesion can occur in any part of the colorectal, more common in the rectum and sigmoid colon, but also in the ascending colon and other parts of the colon, or involving the entire colon, a small total colon involvement and can invade the terminal ileum The affected intestines were mostly limited to the terminal ileum within 10 cm from the ileocecal valve. In the data of 78 cases of ulcerative colitis in the surgical group of the People's Hospital of Beijing Medical University, 38 cases (48.7%) involved in the whole colon; 32 cases in the rectum and sigmoid colon ( 41%); ileum, cecum and ascending colon were affected in 8 cases, accounting for 10.2%; 5 cases (6.4%) were invaded by ileum alone.
2. Pathological morphology
(1) Gross morphology: Ulcerative colitis is a mucosal-based inflammation with fewer complications than Crohn's disease. Therefore, the specimens that have been surgically removed due to complications are not Crohn's disease, and the serosa layer is generally intact. Smooth appearance, luster, vascular congestion, shortening of the intestine, most obvious to the distal colon and rectum, generally no fibrous tissue hyperplasia; the surface of the intestinal mucosa is grainy, brittle, extensively hyperemic and hemorrhagic, with multiple superficial Ulcers, distributed along the colonic band in a linear or plaque-like distribution, severe cases of mucosal exfoliation, and even exposed muscle layer, mucosal lesions are continuous, starting from the rectum or sigmoid colon, often far from the heavy, near-light; The left colon is heavy, the right colon is light, and many inflammatory polyps of different sizes and shapes are seen on the mucosal surface. It is more common in the colon, and the rectum is less common. Sometimes the inflammatory polyps are formed by adhesion to each other. Mucosal bridge.
(2) Histomorphology: mucosa and submucosa are highly congested, edema, diffuse infiltration of inflammatory cells, mainly neutrophils, lymphocytes, plasma cells and macrophages, initial inflammation is limited to mucosa, in the epithelium and glands Inflammation can progress to the submucosa after injury, generally does not involve the muscular layer and serosal layer, neutrophils infiltrate the intestinal epithelium, can lead to cryptitis and crypt abscess, epithelial cell proliferation, goblet cell reduction or disappear, small Most of the ulcers are located in the mucosal layer, which is diffusely distributed, and the bottom reaches the submucosal layer, rarely involving the whole layer; only the thin layer of granulation tissue is seen at the bottom of the ulcer.
Visually observed cases with complete remission after repair, the colonic mucosa is difficult to distinguish from normal mucosa, but pathological examination still has abnormal changes, manifested as irregular glandular ducts, and branches; goblet cells, cell enlargement, Pan Cellular metaplasia, therefore, the most important pathological changes of ulcerative colitis are: 1 diffuse continuous mucosal inflammation; 2 mucosal ulcer; 3 crypt abscess; 4 pseudopolyps; 5 special cell changes, Pan cell proliferation, cup Decreased cells.
Prevention
Ulcerative colitis prevention
Reduce allergic foods and damage to intestinal drug intake, reduce mental burden and trauma, avoid infections, maintain long-term maintenance treatment, and reduce recurrence.
Complication
Ulcerative colitis complications Complications peritonitis colon cancer rectal cancer
1. Toxic megacolon is a serious complication. It is found in acute fulminant ulcerative colitis and acute severe patients. The incidence rate is about 2%. It is often taken with codeine, phenethidine and atropine. Induced by drugs or taking laxatives such as castor oil, it can also be induced during barium enema examination in patients with acute or diarrhea. The dilated colon is mostly in the transverse colon and spleen. The patient has intermittent hyperthermia, and the mental wilting is severely poisoned. State, the abdomen quickly bulging, tenderness, bowel sounds weakened or disappeared, due to rapid expansion of the colon, thinning of the intestinal wall, blood transport disorders, prone to intestinal necrosis and perforation, the mortality rate is extremely high, up to 30% to 50%.
2. Colon perforation occurs on the basis of toxic megacolon expansion. Perforation leads to diffuse peritonitis or localized abscess. The perforation site is mostly in the sigmoid colon or spleen of the colon. Patients often have high fever and symptoms of infection, bloating, left side. Extensive muscle tension in the abdomen, X-ray or plain film often have free gas under the armpit.
3. Lower gastrointestinal bleeding, rectum, colon can be extensively oozing, the vast majority of manifestations of bloody stools, pus and blood, domestic statistics of 2077 cases of lower gastrointestinal bleeding, ulcerative colitis accounted for 8.3%, sometimes a small number of cases (about 4%) can occur repeated bleeding in the lower digestive tract, a large amount of bleeding, up to thousands of milliliters, and even shock, requiring urgent surgery.
4. The incidence of cancer of straight and colon cancer is 0.7% to 8%, even up to 13%, 5 to 20 times higher than the general population, and the course of disease is more than 10 years. The whole colon has extensive lesions as well as adolescents and childhood diseases. The incidence of cancer is significantly increased, cancer can occur in any part of the whole colon, 5% to 42% of polycentric cancer, and the degree of differentiation is low, mostly poorly differentiated mucinous carcinoma, which is a leather-like infiltrating intestinal wall. Therefore, the prognosis is poor, colonoscopy should be performed regularly, and multiple biopsy should be performed on the whole colon in order to find it as soon as possible.
5. The rectum and colon are narrowed, which is a late complication, but rarely causes intestinal obstruction.
6. The internal iliac cavity and the intestinal cavity or intestinal cavity and other hollow organs (such as bladder, vagina, etc.) adhere to each other to form internal hemorrhoids; the intestinal cavity and the skin communicate with each other to form external hemorrhoids, although rare, but occasionally occur.
7. Anal and perianal diseases such as anal fissure, abscess around the rectum, anal fistula, sputum prolapse and so on.
8. Other systemic complications such as non-specific arthritis, nodular erythema, gangrenous pyoderma, iritis, iridocyclitis, keratitis, stomatitis and mumps, as well as fatty liver, small bile duct inflammation, etc. .
Symptom
Ulcerative symptoms of colonic inflammation Common symptoms High heat indigestion Loss and weakness Abdominal discomfort Diarrhea Abdominal pain Nausea black stool with blood constipation
1. Type can be divided into 4 types according to clinical manifestations and processes.
(1) Initial hair style: Symptoms vary in severity, and there is no history of ulceration, which can be converted into chronic recurrent or chronic persistent type.
(2) Chronic recurrence type: The symptoms are mild, the most common in clinical practice. There are often remission periods of different lengths after treatment. The peak of recurrence is mostly in spring and autumn, but less in summer. Colonoscopy in the attack stage has typical ulceration. Conjunctival lesions, but only mild hyperemia, edema, mucosal biopsy is chronic inflammation, prone to irritable bowel syndrome, and some patients can be converted to chronic persistent type.
(3) Chronic persistent type: After the onset, there are often diarrhea of varying severity, intermittent bloody stool, abdominal pain and systemic symptoms, which last for several weeks to several years. There may be an acute attack in this period. The lesion has a wide range and the colonic lesions are carried out. Sexuality, complications, severe symptoms in acute attacks, requiring surgical treatment.
(4) acute fulminant: less domestic reports, accounting for 2.6% of the collapse, foreign reports accounted for 20%, more common in adolescents, rapid onset, systemic and local symptoms are severe, high fever, diarrhea 20 to 30 times a day, More blood in the stool, can cause anemia, dehydration and electrolyte imbalance, hypoproteinemia, weakness and weight loss, and prone to toxic colon expansion, intestinal perforation and peritonitis, often require urgent surgery, high mortality.
2. The main symptoms of diarrhea or constipation, the symptoms at the beginning of the disease is lighter, there is mucus on the surface of the feces, and then increase later, the severe defecation 10 to 30 times a day, the feces often mixed with pus and mucus, can be a paste-like soft stool, blood in the stool Is a more common symptom, mainly due to increased intestinal mucosal ischemia and fibrinolytic activity, usually a small amount of blood in the stool, severe cases can be a large amount of blood in the stool or bloody stool, abdominal pain is more limited to the left lower abdomen or lower abdomen, Mild patients can also have no abdominal pain, with the development of abdominal pain with the disease, can be relieved after defecation, after the urgency, the system is caused by inflammation and stimulation of the rectum, and often have an ankle discomfort. Indigestion often shows anorexia, fullness, belching, upper abdominal discomfort, Nausea, vomiting, etc., systemic performance is more common in acute fulminant patients with severe fever, water and electrolyte imbalance, vitamins, protein loss, anemia, weight loss and so on.
3. Signs of left lower abdomen or total abdominal tenderness, can be sputum and descending colon, especially the sigmoid colon is hard tubular, and there is tenderness, sometimes abdominal muscle tension, anal sphincter spasm can be found in the anus, mucus or bloody mucus secretions, rectum There is tenderness, and some people can touch the liver, which is related to fatty liver.
Examine
Examination of ulcerative colitis
Laboratory inspection
1. Fecal examination: the active period is mushy mucus, pus and blood is the most common. There are a lot of red blood cells and pus cells under the microscope. The quantity changes are often related to the disease condition. A large number of multinuclear macrophages are common in smears. In patients with ulcerative colitis, the fecal occult blood test can be positive. In order to avoid the false positive test of fecal occult blood test caused by oral iron or diet, anti-human hemoglobin antibody with high specificity can be used for examination, and fecal etiological examination can help. Excludes various infectious colitis, and the pathogens that are easily confused include dysentery bacillus, Mycobacterium tuberculosis, Campylobacter jejuni, Salmonella, and Jalania flagellates, followed by amoeba, Clostridium difficile, Chlamydia trachomatis, and giant cells. Virus, sexually transmitted lymphogranuloma virus, herpes simplex virus, Norwalk virus, histoplasma, bud, cryptococcus, Yersin enterocolitica and the like.
2. ESR (ESR): In patients with ulcerative colitis, ESR is often elevated, mostly mild or moderate, and is common in heavier cases, but ESR does not reflect the severity of the disease.
3. White blood cell count: Most patients have normal white blood cell counts, but in acute active, moderate, severe patients may have a slight increase, and severe cases of neutrophil toxic particles.
4. Hemoglobin: 50% to 60% of patients may have varying degrees of hypopigmentation anemia.
5.C-reactive protein (CRP): There are only a small amount of C-reactive protein in normal human plasma, but mild inflammation can also cause hepatocyte synthesis and secretion of protein abnormalities. Therefore, CRP can identify functional and inflammatory bowel disease, damage for 16h. CRP can be elevated before other inflammatory proteins, while fibrinogen and serum mucin are elevated after 24 to 48 hours. In Crohn patients, CRP is higher than patients with ulcerative colitis, suggesting that they have different acute reactions. Phase, when IBD is active, CRP can reflect the clinical status of patients, and patients with surgical treatment often have a continuous increase in CRP; in patients with severe disease, if CRP is high, the response to treatment is slow, and the test is simple and easy. , cheap, more suitable for use in primary hospitals.
6. Immunological examination: Immunological indicators are generally considered to be helpful in judging the activity of the disease, but the significance of the diagnosis of the disease is limited. During the active period, serum IgG, IgA and IgM can be increased, T/B ratio Decreased, in patients with Crohn's disease and some ulcerative colitis, the ratio of interleukin-1 (IL-1) to interleukin-1 receptor (IL-1R) is higher than that of normal people and other inflammatory patients, inflammatory bowel disease The content of IL-1 in the tissue increases, and its content is directly proportional to the activity of the lesion. There are data indicating that macrophages in inflammatory bowel disease are highly active and secrete TNF-, and TNF is measured to understand the pathology of patients with IBD. The degree and activity are important.
Film degree exam
1. X-ray examination: X-ray examination has always been an important method for the diagnosis of ulcerative colitis. Even after colonoscopy, it still has unique value in diagnosis and differential diagnosis, and is an important measure for the diagnosis of ulcerative colitis.
(1) Abdominal plain film: Abdominal plain film has rarely been used in the diagnosis of ulcerative colitis in clinical practice. Its most important value is to diagnose toxic megacolon. For patients with toxic megacolon, it should be performed every 12~24h. Plain film examination to monitor changes in the condition, X-ray showed that the transverse diameter of the colon is more than 5.5cm, the contour can be irregular, and the "fingerprint" sign can appear.
(2) Barium enema examination: barium enema examination is one of the main methods for the diagnosis of ulcerative colitis, but X-ray examination is not helpful for the diagnosis of mild or early cases. It is good for observing mucosal edema and ulcers. The X-ray is mainly as follows:
1 Mucosal folds are rough or have fine particle changes. Some people describe it as "snowflake point" sign, that is, X-ray shows that the intestine is filled with small and dense small tincture points.
2 multiple shallow sputum or small filling defects.
3 The intestine is shortened, and the colonic bag disappears into a tubular shape. In the initial stage, the intestinal wall is contracted, the colonic pocket is enlarged, and the mucosal folds are thickened and disordered. When the ulcer is formed, there are jagged protrusions of different sizes on the edge of the intestinal wall, rectum and sigmoid colon. The fine-grained change can be seen. In the later stage, due to the proliferation of the intestinal wall fibrous tissue, the colonic bag disappears, the wall of the tube becomes hard, the intestinal lumen becomes narrow, the intestinal tube is shortened, and the water is tubular. When the pseudopolyp is formed, there are multiple round defects in the intestinal lumen. .
(3) Selective angiography of the superior mesenteric or inferior mesenteric artery: angiography can visualize the small blood vessels in the lesion, which can provide a powerful help for the diagnosis of this disease. Typical manifestations include interruption of the image of the intestinal wall, stenosis and dilation, vein As in the early days, it showed a high concentration of stains, while the capillaries showed moderate staining.
2. CT and MRI examination In the past, CT was rarely used for the diagnosis of intestinal diseases. In recent years, with the improvement of technology, CT can simulate the imaging changes of endoscopy for the diagnosis of ulcerative colitis.
(1) The intestinal wall is slightly thickened.
(2) There may be an ulcer in the thickened intestinal wall.
(3) In the thickened colon wall, the annular density changes between the outer layers, which are like flower knots or target signs.
(4) can show complications of ulcerative colitis, such as intestinal fistula, perianal abscess, but the intestinal wall thickening shown by CT is non-specific changes, and can not find mild lesions and superficial ulcers of the intestinal mucosa, ulcerative The diagnosis of colitis has certain limitations.
MRI examinations are expensive and have a poor diagnostic effect on intestinal diseases, but may have some value in the diagnosis of extra-intestinal lesions and complications of ulcerative colitis.
Colonoscopy is one of the most important methods for the diagnosis of ulcerative colitis. It can directly observe the changes of the colonic mucosa, determine the basic characteristics and extent of the lesion, and perform biopsy. Therefore, it can be greatly Improving the accuracy of diagnosis of ulcerative colitis is of great value in the diagnosis of this disease. In addition, it plays an important role in the monitoring of ulcerative colitis, but the lesion is severe and suspected to be perforated, and the toxic colon is dilated. Peritonitis or other acute abdomen should be listed as a contraindication for colonoscopy. Endoscopic mucosal morphological changes are mainly characterized by erosion, ulceration and pseudopolyposis, manifested as: multiple superficial ulcers with mucosa, with congestion, Edema, lesions from the rectum began, diffuse distribution; mucosal roughness is fine granular, mucosal blood vessels are blurred, brittle and easy to hemorrhage; repeated lesions can be seen by the author of false polyps, colonic bags disappeared, intestinal wall thickening and other performance.
(1) During the active period, the changes in the same intestinal segment were almost uniform. The initial stage was mainly mucosal congestion, edema, vascular texture disorder, blurred, thickening of the meniscus, and the intestines often showed a sputum state; then the mucosal surface became rough and appeared. Diffuse distribution, fine particles of uniform size, tissue becomes brittle, there is natural bleeding or contact bleeding, mucus secretion in the cavity; further development, mucosal erosion, accompanied by many scattered yellow spots, is a crypt abscess After the formation of purulent secretions attached to the opening of the duct; and the formation of many ulcers on the posterior mucosa, the ulcer is small and superficial, needle-like, linear or patchy, irregular shape, irregular arrangement, around the longitudinal axis of the intestine The horizontal axis is interlaced, which is an important feature of endoscopic ulcerative colitis. The surrounding mucosa also has obvious inflammatory reactions such as congestion and erosion, and almost no normal residual mucosa is visible.
(2) In the remission period, the main manifestations of endoscopy are mucosal atrophy and inflammatory pseudopolyps. Because the pathological changes of this disease generally do not exceed the submucosa, no fibrosis and scars are formed, which can be completely restored to normal. After the inflammation subsides, the intestinal mucosa is congested, the edema gradually disappears, the ulcer shrinks into a thin line or the healing disappears, and the exudate absorbs; in the case of chronic persistent or relapsing remission, the intestinal mucosa shows atrophic changes, the color becomes pale, and the blood vessels Texture disorder, mucous membrane normal luster loss, slightly dry, residual mucosal islands can form pseudopolyps due to epithelial and a small amount of fibrous tissue hyperplasia, pseudopolyps are indeterminate, vary in size, can be pedunculated or pedunculated, mucosal bridge is Ulcers repeatedly dig down, and the marginal epithelium continues to proliferate, and the ulcers are relatively healed and connected, and the ends are connected with the mucosal surface and the bridge shape is suspended in the middle, which is not unique to ulcerative colitis.
(3) In the advanced stage, severe and recurrent ulcerative colitis may occur, the colonic bag disappears, the intestine is shortened, the intestinal lumen is narrow, and the mucosal surface is rough and insect bites, forming a so-called lead-like colon on the X-ray.
Fulminant ulcerative colitis is the most common cause of toxic megacolon. Endoscopic examination shows that the lesion involves the entire colon, the normal morphology disappears, the intestinal lumen expands, the colonic pouch and the meniscus disappear, and the mucosa is obviously congested, erosive, and hemorrhagic. See ulcer formation, large mucosal exfoliation, due to the thin intestinal wall, it must be pointed out that explosive ulcerative colitis and toxic megacolon should be contraindicated endoscopy, otherwise it is easy to cause perforation or further increase the lesion.
Colonic biopsy shows an inflammatory reaction. According to the structure of the crypt, the degree of inflammatory cell infiltration in the lamina propria and the distribution of inflammation, acute and chronic lesions can be distinguished to smash, ulcer, crypt abscess, gland abnormalities. Arrangement, goblet cell reduction and epithelial changes are more common, the shape of the crypt is irregular, dilatation or branching is a manifestation of chronic ulcerative colitis, and there may be crypt shrinkage, deforming the mucosal surface, and visible neutrophils in the lamina propria. Infiltration of inflammatory cells such as cells, monocytes, and plasma cells can also be seen in the metaplasia of Paneth cells (Pan's cells).
According to endoscopy, there are many methods for grading active ulcerative colitis, and the Miner classification method is adopted by more scholars.
Grade 0: The mucous membrane is pale, the vascular network is clear, and it is branched. The small nodules are seen under the mucosa, and the surface mucosa is normal.
Grade I: The mucous membrane is still smooth, but it is congested, edema, and enhanced in refraction.
Grade II: mucosal congestion, edema, granular, mucoid fragility, contact with bleeding or scattered spontaneous bleeding.
Grade III: The mucosa is obviously congested, edematous, rough, obvious spontaneous bleeding and contact bleeding, with more inflammatory secretions, multiple erosions and ulcer formation.
4. Ultrasound imaging is difficult to obtain satisfactory results due to the interference of gas and liquid in the intestinal lumen. Therefore, ultrasound imaging is considered to be unsuitable for the examination of gastrointestinal diseases, but there are still scholars dedicated to ultrasound in the gastrointestinal Exploring the value of application in disease diagnosis, the researchers suggest that the main ultrasound sign of ulcerative colitis is thickening of the intestinal wall, ranging from 4 to 10 mm (normally 2 to 3 mm); at the same time, it can show the location, extent and distribution of the lesion.
Diagnosis
Diagnosis and diagnosis of ulcerative colitis
diagnosis
1. Diagnostic criteria Because ulcerative colitis is a non-specific inflammatory disease, its clinical manifestations are diverse, and it is difficult to find typical clinical features for diagnosis. In 1993, the National Symposium on Chronic Non-infectious Enteric Diseases was held in China. According to the international diagnostic criteria combined with the specific conditions of China, the diagnostic criteria for ulcerative colitis are proposed: 1 to exclude bacterial dysentery, amebic colitis, schistosomiasis, intestinal tuberculosis, Crohn's disease, radiation enteritis and other reasons for colonic inflammation; 2 has typical clinical manifestations, and at least one of the characteristic changes of endoscopy or X-ray; 3 clinical symptoms are atypical, but with typical colonoscopy or X-ray findings or confirmed by pathological biopsy.
2. Severity judgment Truelove and Witts classify ulcerative colitis into light, medium and heavy type 3 according to clinical manifestations and laboratory results. This assessment helps clinicians to estimate the condition and provide a basis for treatment.
According to Edwards, general mild ulcerative colitis accounts for 54%, lesions involve only the rectum and sigmoid colon; 27% of patients with ulcerative colitis have a moderate degree of disease; 19% of patients show severe ulcerative colitis, except diarrhea, bloody stools In addition to symptoms such as anemia and weight loss, 117 cases of ulcerative colitis in the domestic group accounted for 21% of light, 52% of medium-sized, and 27% of heavy.
Differential diagnosis
1. Crohn's disease.
2. Irritable bowel syndrome: the incidence is related to mental and psychological disorders, often abdominal pain, bloating, abdominal sputum, alternating constipation and diarrhea, with symptoms of systemic neurosis, mucus with mucus but no pus, microscopic examination Occasionally, a few white blood cells, colonoscopy and other examinations have no organic lesions.
3. Rectal colon cancer: more common in the middle-aged population, rectal cancer often refers to the tumor when the examination, the occult blood test is often positive, colonoscopy and barium enema examination is valuable for differential diagnosis, but with ulcerative colitis cancer Disguised identification.
4. Chronic amoebic dysentery: lesions often involve the two sides of the large intestine, namely rectum, sigmoid colon and cecum, ascending colon, ulcers are generally deep, marginal sneak, mucosa between ulcers and ulcers is mostly normal, stool examination can find dissolved tissue Miba trophozoites or cysts, through the colonoscopy to take the ulcer surface exudate or ulcer edge tissue to find amoeba, the positive rate is higher; anti-amebic treatment is effective.
5. Colonic schistosomiasis; history of contact with schistosomiasis water, often hepatosplenomegaly, chronic granuloma may have granuloma-like hyperplasia, may have malignant tendency; fecal examination can find schistosomiasis eggs, hatching hairy positive results, proctoscopy Examination of the mucous membranes in the acute phase showed yellow-brown granules, biopsy mucosal compression or histopathological examination revealed schistosomiasis eggs.
6. Chronic bacterial dysentery: There is a general history of acute dysentery. Multiple times of fresh fecal culture can isolate dysentery bacilli, and antibiotic treatment is effective.
7. Ischemic colitis: more common in the elderly, caused by arteriosclerosis, sudden onset, lower abdominal pain with vomiting, bloody diarrhea after 24 to 48 hours, fever, increased white blood cells, light is a reversible process, after l ~ 2 weeks to 1 to 6 months can be cured; severe cases of intestinal necrosis, perforation, peritonitis, barium enema X-ray examination, visible finger marks, pseudo-tumor, serrated changes in the intestinal wall and intestinal stenosis Etc. Endoscopically, the dark purple bulge caused by submucosal hemorrhage, the exfoliation and mucosal exfoliation of the mucosa, and the normal mucosa are clearly demarcated, and the lesion is mostly in the spleen of the colon.
8. Others: The diseases that must be identified include intestinal tuberculosis, pseudomembranous colitis, radiation enteritis, colon polyposis, and colonic diverticulum.
